Healthcare Provider Details

I. General information

NPI: 1164147716
Provider Name (Legal Business Name): FACETIME AESTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 SUNNYBROOK DR
MANCHESTER CT
06040-6660
US

IV. Provider business mailing address

122 SUNNYBROOK DR
MANCHESTER CT
06040-6660
US

V. Phone/Fax

Practice location:
  • Phone: 860-803-1255
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA COSTA
Title or Position: FOUNDER
Credential:
Phone: 860-803-1255